US20150164503A1 - Buttress support design for eea anvil - Google Patents
Buttress support design for eea anvil Download PDFInfo
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- US20150164503A1 US20150164503A1 US14/628,966 US201514628966A US2015164503A1 US 20150164503 A1 US20150164503 A1 US 20150164503A1 US 201514628966 A US201514628966 A US 201514628966A US 2015164503 A1 US2015164503 A1 US 2015164503A1
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- United States
- Prior art keywords
- buttress
- anvil
- mount
- staple
- component
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1132—End-to-end connections
Definitions
- the present disclosure relates to a surgical instrument for applying surgical fasteners or staples to body tissue, and more particularly, to a surgical buttress assembly for use with an end-to-end anastomosis stapling apparatus.
- Anastomosis is a surgical joining of separate hollow organ sections.
- an anastomosis procedure follows surgery in which a diseased or defective section of hollow tissue is removed and the remaining end sections are joined.
- the end sections may be joined by either circular, end-to-end or side-to-side organ reconstruction methods.
- a stapling instrument which drives a circular array of staples through the end section of each organ section and simultaneously cores any tissue interior of the driven circular array of staples to free the tubular passage.
- these instruments include an elongated shaft having a handle portion at a proximal end to actuate the instrument and a staple holding component disposed at a distal end.
- An anvil assembly including an anvil shaft with attached anvil head is mounted to the distal end adjacent the staple holding component.
- Opposed end sections of the organ to be stapled are clamped between the anvil head and the staple holding component.
- the clamped tissue is stapled by driving a plurality of staples from the staple holding component so that the ends of the staples pass through the tissue and are deformed by the anvil head.
- one end section of the organ is secured about the anvil assembly and the other end section of the organ is held in place adjacent the staple holding component.
- the shaft of the anvil assembly is removably connected to the instrument. Once the anvil shaft is secured to the instrument, the anvil is drawn into close approximation to the staple holding component.
- the instrument is then fired to cause the staples to pass through tissue of both sections of the organ and deform against the anvil.
- a circular knife is advanced to cut tissue inside the staple line, thereby establishing a passage between the two sections of the organ.
- the instrument is typically removed by withdrawing the anvil through the staple line, after which the surgeon will carefully inspect the surgical site to ensure a proper anastomosis has been achieved.
- an apparatus for joining two hollow organ sections with an annular array of surgical staples includes a staple cartridge component, an anvil component, a buttress member and a buttress mount.
- the staple cartridge component includes a plurality of surgical staples in an annular array.
- the anvil component includes an anvil member and a shaft extending therefrom.
- the anvil member defines a plurality of staple pockets for deforming the surgical staples.
- the anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to adjustably clamp tissue between the staple cartridge and anvil components.
- the buttress member is concentrically aligned with the plurality of staple pockets defined in the anvil member.
- the buttress mount is detachably secured with the shaft of the anvil component.
- the buttress mount includes at least one support member radially extending outward to secure the buttress member to the anvil member.
- the buttress mount at least partially underlying the buttress member to provide support thereto.
- the buttress mount may further include an annular ring member from which the at least one support member radially extends outward.
- the annular ring member may be configured and dimensioned to receive the shaft of the anvil component therethrough.
- the at least one support member may be disposed radially inward of the plurality of staple pockets. A radially outer peripheral portion of the at least one support member may be flush with a peripheral edge of the anvil member.
- the at least one support member may also extend radially outward of at least one of the annular rows of staple pockets. Alternatively, the at least one support member may at least partially overlie at least one of the annular rows of staple pockets.
- the at least one support member may have a radially varying thickness.
- the buttress member may have an annular configuration.
- the buttress member may be disposed in a juxtaposed relation with the plurality of staple pockets.
- the buttress mount may engage a proximal surface of the buttress member.
- the buttress mount may engage a distal surface of the buttress member.
- the buttress member may be made of a biodegradable material.
- the anvil member may define a recess configured and dimensioned to receive the buttress mount therein to provide securement of the buttress mount therein.
- the at least one support member of the buttress mount may engage an inner wall of the recess to provide securement of the buttress mount thereagainst.
- the buttress member and the buttress mount may be monolithically formed as a single construct.
- the apparatus may further include a knife member concentrically arranged with the plurality of surgical staples in the staple cartridge component.
- the knife member may be movable relative to the staple cartridge component.
- the at least one support member of the buttress mount may be disposed radially inward of the knife member when the knife member engages the buttress member.
- an apparatus for joining two hollow organ sections with an annular array of surgical staples includes a staple cartridge component, an anvil component, a knife member, a buttress member, and a buttress mount.
- the staple cartridge component includes a plurality of surgical staples in an annular array.
- the anvil component defines a plurality of staple pockets for deforming the surgical staples.
- the anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to adjustably clamp tissue between the staple cartridge and anvil components.
- the knife member is concentrically arranged with the plurality of surgical staples in the staple cartridge component. The knife member is movable relative to the staple cartridge component.
- the buttress member is concentrically aligned with the anvil component.
- the buttress mount is detachably secured with the anvil component.
- the buttress mount includes a core ring, an outer ring, and at least one spoke extending between and interconnecting the core ring and the outer ring.
- the buttress mount is configured and adapted to secure the buttress member with the anvil member.
- the buttress mount at least partially underlying the buttress member to provide support thereto.
- the buttress member may be concentrically aligned with the plurality of staple pockets.
- the outer ring may at least partially overlap the plurality of staple pockets in the annular array.
- the buttress mount may engage a proximal surface of the buttress member.
- the buttress mount may engage a distal surface of the buttress member.
- the outer ring may be disposed radially inward of the knife member when the knife member is actuated to engage the buttress member.
- an apparatus for joining two hollow organ sections with an annular array of surgical staples includes a handle assembly, an elongate tubular member, a staple cartridge component, an anvil component, a knife member, a buttress member, and a buttress mount.
- the handle assembly includes a firing trigger.
- the elongate tubular member extends distally from the handle assembly.
- the staple cartridge component is coupled to a distal portion of the elongate tubular member.
- the staple cartridge component includes a plurality of surgical staples in an annular array.
- the anvil component defines a plurality of staple pockets for deforming the surgical staples.
- the anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to clamp tissue between the staple cartridge and anvil components.
- the knife member is concentrically arranged with the plurality of surgical staples in the staple cartridge component.
- the knife member is movable relative to the staple cartridge component.
- the buttress member is concentrically aligned with the anvil component.
- the buttress mount is detachably secured with the anvil component.
- the buttress mount includes at least one support member radially extending outward, from a shaft of the anvil component when the buttress mount is mounted on the anvil component to secure the buttress member to the anvil component.
- the buttress mount at least partially underlies the buttress member to provide support thereto.
- the buttress mount may further include an annular ring member from which the at least one support member radially extends outward.
- the at least one support member may be disposed radially inward of the plurality of staple pockets.
- a peripheral portion of the at least one support member may be flush with a peripheral edge of the anvil member.
- the at least one support member may extend radially outward of at least one of the annular rows of staple pockets.
- the at least one support member may at least partially overlie at least one of the annular rows of staple pockets.
- FIG. 1 is a perspective view of an annular surgical stapling apparatus configured for use with a surgical buttress assembly in accordance with an embodiment of the present disclosure, illustrating an anvil assembly and the buttress assembly detached from the surgical stapling apparatus;
- FIG. 2 is an exploded perspective view of the anvil assembly and the buttress assembly of the surgical stapling apparatus of FIG. 1 with parts separated;
- FIG. 3 is a perspective view of the anvil assembly of FIG. 2 having the buttress assembly of FIG. 2 mounted thereon;
- FIG. 4 is a cutaway perspective view of the area of detail indicated in FIG. 3 ;
- FIG. 5 is an exploded perspective view of the anvil assembly and the buttress assembly of FIG. 2 with parts separated, illustrating invertible use of the buttress assembly;
- FIG. 6 is a perspective view of the anvil assembly of FIG. 5 having the buttress assembly of FIG. 5 mounted thereon;
- FIG. 7 is an exploded perspective view of the anvil assembly of FIG. 1 and a buttress assembly in accordance with another embodiment of the present disclosure, with parts separated;
- FIG. 8 is a perspective view of the anvil assembly of FIG. 1 having a buttress assembly in accordance with another embodiment of the present disclosure mounted thereon;
- FIG. 9 is a cutaway perspective view of the area of detail indicated in FIG. 8 ;
- FIG. 10 is a perspective view of the anvil assembly of FIG. 1 having a buttress assembly in accordance with another embodiment of the present disclosure mounted thereon;
- FIG. 11 is a cutaway perspective view of the area of detail indicated in FIG. 10 ;
- FIG. 12 is an exploded perspective view of the anvil assembly of FIG. 1 and a buttress assembly in accordance with another embodiment of the present disclosure with parts separated;
- FIG. 13 is a side cross-sectional view of a buttress assembly of FIG. 12 taken along section line 13 - 13 in FIG. 12 ;
- FIG. 14 is a perspective view of the annular surgical apparatus of FIG. 1 , illustrating insertion of the apparatus through two hollow organ sections;
- FIG. 15 is an enlarged, partial longitudinal cross-sectional view of a head portion of the apparatus of FIG. 14 ;
- FIG. 16 is an enlarged view of the area of detail indicated in FIG. 15 ;
- FIG. 17 is an enlarged, partial longitudinal cross-sectional view of the head portion of the apparatus of FIG. 15 , illustrating stapling and cutting of the two hollow organ sections.
- distal as is conventional, will refer to that portion of the instrument, apparatus, device or component thereof which is farther from the user while, the term “proximal,” will refer to that portion of the instrument, apparatus, device or component thereof which is closer to the user.
- proximal will refer to that portion of the instrument, apparatus, device or component thereof which is closer to the user.
- Surgical stapling apparatus 10 for performing circular anastomosis of hollow organs is shown.
- Surgical stapling apparatus 10 drives a circular array of staples 7 ( FIG. 15 ) through the end sections of each organ and simultaneously fires an annular knife 76 ( FIG. 15 ) to sever any tissue interior of the driven circular array of staples 7 to free the tubular passage, and thereby joining two ends of the organ.
- Surgical stapling apparatus 10 includes a handle assembly 20 having a pair of pivotable actuating handle members 22 and an advancing means 24 including a rotatable grip member 26 , an elongate body portion 30 extending distally from handle assembly 20 , and a head portion 50 including an anvil assembly 60 , a staple cartridge assembly 70 , and a surgical buttress assembly 100 in accordance with an embodiment of the present disclosure.
- the components of surgical apparatus 10 are generally formed from thermoplastics including polycarbonates, and metals including stainless steel and aluminum. The particular material selected to form a particular component will depend upon the strength requirements of the particular component.
- Staples 7 are of a conventional type and include a backspan having a pair of legs extending from the backspan. The legs terminate in tissue penetrating tips.
- Handle assembly 20 can be actuated to approximate anvil assembly 60 relative to staple cartridge assembly 70 and to apply a pair of annular arrays of staples 7 through tissue.
- rotatable grip member 26 may be rotated to move anvil assembly 60 axially relative to staple cartridge assembly 70 between a spaced apart position and an approximated position in which anvil assembly 60 is positioned adjacent staple cartridge assembly 70 to clamp tissue therebetween.
- Handle members 22 may be squeezed to fire staples 7 through tissue to join two segments “T 1 ,” “T 2 ” ( FIG. 14 ) of tubular tissues together, as will be discussed in detail below.
- Elongate body portion 30 is constructed to have a slightly curved/bent shape along its length. However, elongate body portion 30 may also be straight, as well as flexible to bend to any configuration. The length, shape and/or the diameter of elongate body portion 30 may be varied to suit a particular surgical procedure.
- head portion 50 includes, a staple cartridge assembly 70 , an anvil assembly 60 and a surgical buttress assembly 100 detachably secured with anvil assembly 60 .
- Staple cartridge assembly 70 may be fixedly connected to a distal end portion of elongate body portion 30 or may be configured to concentrically fit within the distal end portion of elongate body portion 30 .
- staple cartridge assembly 70 defines a pair of annular arrays of staple receiving slots 72 ( FIG. 15 ) having a staple 7 disposed in each one of staple receiving slots 72 .
- staple cartridge assembly 70 includes a cylindrical knife 76 concentrically arranged with the pair of annular array of staples 7 and a plurality of staple pushers 9 ( FIG. 15 ) each disposed in staple receiving slot 72 to eject staple 7 through slot 72 .
- Staples 7 travel through slots 72 and tissue toward anvil assembly 60 .
- cylindrical knife 76 includes a distal rim 79 defining a knife blade adapted to cut tissue and portions of surgical buttress assembly 100 .
- cylindrical knife 76 is moved distally to cut tissue and portions of surgical buttress assembly 100 , and the plurality of pushers 9 are moved distally to eject staples 7 from the staple receiving slots 72 toward anvil assembly 60 .
- anvil assembly 60 including an anvil member 62 and a shaft 64 extending proximally from anvil member 62 .
- Anvil member 62 includes a plurality of staple pockets 65 for receiving and deforming staples 7 .
- Shaft 64 is configured to be detachably received in approximation shaft 75 ( FIG. 1 ) disposed in elongate body portion 30 .
- Approximation shaft 75 is operatively coupled with rotatable grip member 26 of handle assembly 20 , whereby rotation of rotatable grip member 26 moves approximation shaft 75 axially. Such axial movement of approximation shaft 75 is imparted to anvil assembly 60 .
- anvil assembly 60 is movable axially relative to staple cartridge assembly 70 between a spaced apart position and an approximated position in which anvil assembly 60 is positioned adjacent staple cartridge assembly 70 to adjustably clamp tissue between anvil assembly 60 and staple cartridge assembly 70 .
- buttress member 110 and a buttress mount 120 are concentrically arranged with one another.
- Buttress member 110 is provided to reinforce and seal staple lines applied to tissue by surgical stapling apparatus 10 .
- Buttress member 110 is fabricated from a biocompatible material which is bioabsorbable or non-absorbable, and can also be made from natural or synthetic materials. It should be understood that any combination of natural, synthetic, bio-absorbable, and non-bioabsorbable materials may be used to form buttress member 110 .
- buttress member 110 may be porous, non-porous, or combinations thereof. It is also envisioned that buttress member 110 described herein may contain a plurality of layers in which any combination of non-porous and porous layers may be configured. For example, buttress member 110 may be formed to include multiple non-porous layers and porous layers that are stacked in an alternating manner. In another example, buttress member 110 may be formed in a “sandwich-like” manner wherein the outer layers of buttress member 110 include porous layers and the inner layers are non-porous layers. Examples of multi-layered buttress members are disclosed in U.S. Patent Application Publication No. 2009/0001122, filed on Jun. 27, 2007, entitled “Buttress and Surgical Stapling Apparatus,” the entire disclosure of which is hereby incorporated by reference therein.
- non-porous layers in buttress member 110 may enhance the ability of buttress member 110 to resist tears and perforations during the manufacturing, shipping, handling, and stapling processes.
- use of a non-porous layer in the surgical buttress may also retard or inhibit tissue ingrowth from surrounding tissues, and thereby act as an adhesion barrier and/or inhibit the formation of unwanted scar tissue.
- bioactive agent may be combined with buttress member 110 .
- the agent may be disposed on a surface of the surgical buttress and/or impregnated therein.
- buttress member 110 can also serve as a vehicle for delivery of the bioactive agent.
- bioactive agent as used herein, is used in its broadest sense and includes any substance or mixture of substances that have clinical use.
- buttress member 110 has an annular profile configured to be concentrically aligned with anvil assembly 60 .
- buttress member 110 is mounted on a proximal surface 66 of anvil assembly 60
- buttress mount 120 is disposed proximal of buttress member 110 .
- the annular profile of buttress member 110 is configured and dimensioned to at least be flush with an outer peripheral edge of anvil member 62 when mounted on anvil assembly 60 .
- Buttress mount 120 includes a core ring 122 and support arms 124 radially extending outward from core ring 122 .
- Support arms 124 are circumferentially arranged about core ring 122 and are configured and dimensioned to be affixed to a proximal surface 112 of buttress member 110 by, for example, over molding, ultrasonic welding, melt pressing or melt pressing in conjunction with other polymers or with adhesives.
- Core ring 122 includes a hole 123 configured and dimensioned to receive shaft 64 of anvil assembly 60 therethrough when being mounted to anvil assembly 60 .
- hole 123 is configured and dimensioned to provide a tight or friction fit against shaft 64 to enable securement of buttress member 110 between anvil member 62 and buttress mount 120 .
- core ring 122 may be configured as a split ring (i.e., including a break along a length thereof) to accommodate various diameter shafts.
- buttress support may incorporate straight or curved members having a variety of cross-sectional shapes.
- buttress member 110 is in a superposed relation with the pair of annular arrays of staple pockets 65 defined in anvil member 62 .
- radially extending support arms 124 of buttress mount 120 are configured and sized to terminate radially inward of the pair of annular arrays of staple pockets 65 , such that when staples 7 are ejected through the pair of annular arrays of staple receiving slots 72 , the legs of each staple 7 penetrate through tissue and buttress member 110 into staple pockets 65 .
- support arms 124 of buttress mount 120 are not affected by the staple formation and, likewise, the support arms do not affect the staple formation.
- support arm 124 may be configured and sized to terminate radially inward of cylindrical knife 76 when cylindrical knife 76 is actuated to cut tissue and buttress mount 120 . In this manner, severing of support arm 124 by cylindrical knife 76 may be eliminated.
- buttress assembly 100 may be used in an inverted position.
- buttress mount 120 is secured with buttress member 110 , by any of the methods described hereinabove, so that the buttress mount 120 is arranged distal of buttress member 110 .
- buttress mount 120 may be configured and dimensioned to be received in a recess 67 defined in anvil member 62 .
- a hole 123 defined by core ring 122 provides a tight fit against shaft 64 of anvil assembly 60 .
- support arms 124 are configured and dimensioned to provide a tight fit with a peripheral edge of recess 67 , which further improves the securement of buttress member 110 with anvil assembly 60 .
- buttress mount 120 with respect to buttress member 110 can provide a flat surface contact between buttress member 110 and the proximal surface 66 of anvil member 62 , to thereby further enhance staple formation through tissue.
- buttress member 110 may be supported by a pair of buttress mounts 520 a , 520 b .
- buttress mount 520 a is arranged distal of buttress member 110
- buttress mount 520 b is arranged proximal of buttress member 110 .
- Buttress mounts 520 a , 520 b are attached to buttress member 110 by any of the methods described hereinabove.
- Buttress mounts 520 a , 520 b are substantially identical to buttress mount 120 described hereinabove, and thus will not be described herein in the interest of brevity.
- Buttress mounts 520 a , 520 b are substantially identical and as such, buttress assembly 500 may be used interchangeably. Holes 523 of respective buttress mounts 520 a , 520 b are configured and dimensioned to receive shaft 64 of anvil assembly 60 therethrough to provide a tight or friction fit therewith.
- buttress mount 520 a include support arms 524 radially extending outward from core ring 522 to provide a tight fit around the peripheral edge of recess 67 of anvil assembly 60 to further improve securement of buttress member 110 with anvil assembly 60 .
- buttress mount 520 b may also include support arms 524 configured and dimensioned to provide a tight fit against the peripheral edge of recess 67 of anvil assembly 60 . While support arms 524 of buttress mount 520 a are shown to be in radial registration with support arms 524 of buttress mount 520 b , it is contemplated that support arms 524 of buttress mounts 520 a , 520 b may be out of radial registration with one another.
- the buttress mounts 520 a and 520 b may have different configurations including arms that are curved or straight, having a variety of cross-sectional shapes. The configuration of buttress mount 520 a may be different from the configuration of buttress mount 520 b.
- a buttress mount 220 may include support arms 224 that radially extend outward from a core ring 222 and that are substantially flush with an outer peripheral edge of anvil member 62 when mounted on anvil assembly 60 . Under such a configuration, a portion of each support arm 224 is stapled to tissue to reinforce tissue, and the remaining portions (i.e., portions radially inward of cylindrical knife 76 ) of buttress member 110 and buttress mount 120 are cut and detached from the portion of buttress member 110 that is stapled to tissue.
- support arms 224 may have varying thickness.
- a portion of support arm 224 that is stapled to tissue may have a minimal thickness, e.g., a thickness substantially smaller than the thickness of a portion of support arm 224 adjacent core ring 222 , such that any effect of the thickness of support arms 224 on staple formation is minimized.
- the portion of support arms 224 that are stapled with buttress member 110 may be formed of bioabsorbable and/or biodegradable material.
- Buttress mount 320 in accordance with another embodiment of the present disclosure is illustrated.
- Buttress mount 320 includes a core ring 322 configured and dimensioned to receive shaft 64 of anvil assembly 60 therethrough, an outer ring 326 concentrically arranged with core ring 322 and spokes 324 radially extending outward from core ring 322 to outer ring 326 , thereby interconnecting core ring 322 and outer ring 326 .
- Outer ring 326 provides additional support for buttress member 110 against anvil member 62 .
- outer ring 326 may greatly reduce the potential for buttress member 110 to fold over, dislodge or separate from anvil assembly 60 .
- the force applied to buttress member 110 by buttress mount 320 is more evenly distributed throughout buttress member 110 , which may inhibit tear or damage to buttress member 110 .
- outer ring 326 is at least partially disposed in the staple formation portion of buttress member 110 , whereby only a portion of outer ring 326 is stapled to buttress member 110 and tissue, and the remaining portions of outer ring 326 are cut and detached from the portion of buttress member 110 stapled to tissue.
- outer ring 326 may have a minimal thickness at a peripheral portion thereof to minimize interference with staple formation.
- outer ring 326 and/or buttress mount 320 may be made of biodegradable and/or bioabsorbable material, such that the portion of outer ring 326 that is stapled to buttress member 110 and tissue is degraded over time.
- the outer ring 326 can be positioned inwardly of the staple line, or inwardly of the cut line.
- buttress mounts 120 , 220 , 320 and buttress member 110 have been described hereinabove as separate components that are attached to each other by the methods describe hereinabove, it is also envisioned that buttress member and buttress support may be monolithically formed as a single construct.
- Monolithically formed buttress assembly 400 defines a common through hole 423 configured and dimensioned to receive shaft 64 of anvil assembly 60 therethrough to provide a tight fit therewith.
- the buttress member and buttress support can be formed from different materials that are bonded or otherwise attached to one another.
- surgical stapling apparatus 10 is used in an anastomosis procedure to effect joining of, for example, two opposing intestinal sections “T 1 ,” “T 2 .”
- the anastomosis procedure is typically performed using minimally invasive surgical techniques including laparoscopic means and instrumentation. Initially, a diseased intestinal section is removed.
- anvil assembly 60 is inserted to the operative site either through a surgical incision or transanally and is positioned within the intestinal section “T 1 .”
- Elongate body portion 30 of surgical stapling apparatus 10 including staple cartridge assembly 70 is inserted transanally into the other intestinal section “T 2 .”
- Intestinal sections “T 1 ,” “T 2 ” are then temporarily secured about their respective components (e.g., shaft 64 of anvil assembly 60 and the distal end of elongate body portion 30 ) by conventional means such as a purse string suture “P.”
- anvil assembly 60 maneuvers anvil assembly 60 until the proximal end of shaft 64 is inserted into the distal end of approximation shaft 75 disposed in elongate body portion 30 of surgical stapling apparatus 10 .
- Shaft 64 engages approximation shaft 75 to be operable as a unitary construct, as shown in FIG. 15 .
- Anvil assembly 60 and elongate body portion 30 are then approximated to approximate intestinal sections “T 1 ,” “T 2 ,” as shown in FIG. 17 .
- Surgical stapling apparatus 10 is then fired, effecting stapling of intestinal sections “T 1 ,” “T 2 ” to one another, while cylindrical knife 76 cuts a portion of buttress member 110 and tissue disposed radially inward of cylindrical knife 76 , and thereby detaching buttress mount 320 and an inner portion of buttress member 110 from the portion of buttress member 110 that is clamped (approximated) between distal surface 74 of staple cartridge assembly 70 and proximal surface 66 of anvil assembly 60 to complete the anastomosis.
- a buttress member can be superposed in relation with the annular rows of staple slots defined in the staple cartridge assembly 70 .
- radially extending support arms of buttress mount are attached to a core ring and are configured and sized to terminate radially inward of the pair of annular rows of staple slots 72 (see FIG. 15 ), such that when staples 7 are ejected through the pair of annular arrays of staple receiving slots 72 , the legs of each staple 7 penetrate through tissue and buttress member into staple pockets 65 .
- the support arms can terminate adjacent the rows of staple slots 72 .
- a portion of buttress member is stapled with tissue to reinforce tissue, and the remaining portions of buttress member and/or buttress mount are cut and detached from the portion of buttress member stapled with tissue.
- the support arms can be configured to engage the inner surface of a recess in the staple cartridge assembly. Additionally or alternatively, the core ring of the buttress support frictionally engages the shaft.
- a pair of buttress supports can be used to mount the buttress member on the staple cartridge, as discussed above.
- buttress member and buttress support may be secured with approximation shaft 75 disposed in staple cartridge assembly 70 , whereby buttress assembly 100 is in a superposed relation with a tissue contacting surface of staple cartridge assembly 70 . It is to be understood, therefore, that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure.
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Abstract
Description
- This application is a continuation and claims the benefit of and priority to of U.S. patent application Ser. No. 13/358,544, filed Jan. 26, 2012, the entire disclosure of which is incorporated by reference herein.
- 1. Technical Field
- The present disclosure relates to a surgical instrument for applying surgical fasteners or staples to body tissue, and more particularly, to a surgical buttress assembly for use with an end-to-end anastomosis stapling apparatus.
- 2. Background of Related Art
- Anastomosis is a surgical joining of separate hollow organ sections. Typically, an anastomosis procedure follows surgery in which a diseased or defective section of hollow tissue is removed and the remaining end sections are joined. Depending on the desired anastomosis procedure, the end sections may be joined by either circular, end-to-end or side-to-side organ reconstruction methods.
- In a circular anastomosis procedure, the two ends of the organ sections are joined by means of a stapling instrument which drives a circular array of staples through the end section of each organ section and simultaneously cores any tissue interior of the driven circular array of staples to free the tubular passage. Typically, these instruments include an elongated shaft having a handle portion at a proximal end to actuate the instrument and a staple holding component disposed at a distal end. An anvil assembly including an anvil shaft with attached anvil head is mounted to the distal end adjacent the staple holding component. Opposed end sections of the organ to be stapled are clamped between the anvil head and the staple holding component. The clamped tissue is stapled by driving a plurality of staples from the staple holding component so that the ends of the staples pass through the tissue and are deformed by the anvil head.
- In use, one end section of the organ is secured about the anvil assembly and the other end section of the organ is held in place adjacent the staple holding component. The shaft of the anvil assembly is removably connected to the instrument. Once the anvil shaft is secured to the instrument, the anvil is drawn into close approximation to the staple holding component. The instrument is then fired to cause the staples to pass through tissue of both sections of the organ and deform against the anvil. During the firing step, a circular knife is advanced to cut tissue inside the staple line, thereby establishing a passage between the two sections of the organ. After firing, the instrument is typically removed by withdrawing the anvil through the staple line, after which the surgeon will carefully inspect the surgical site to ensure a proper anastomosis has been achieved.
- While circular staplers are helpful in a number of surgical procedures, problems such as anastomotic leak, tearing of tissue during stapler extraction, bleeding, and other complications may arise. In order to remedy such problems, buttress or reinforcing materials have been utilized. However, due to the inherent difficulty in positioning and securing such materials with the instrument, a need exists for the buttress material that can be safely and effectively positioned with the anvil.
- In accordance with an embodiment of the present disclosure, there is provided an apparatus for joining two hollow organ sections with an annular array of surgical staples. The apparatus includes a staple cartridge component, an anvil component, a buttress member and a buttress mount. The staple cartridge component includes a plurality of surgical staples in an annular array. The anvil component includes an anvil member and a shaft extending therefrom. The anvil member defines a plurality of staple pockets for deforming the surgical staples. The anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to adjustably clamp tissue between the staple cartridge and anvil components. The buttress member is concentrically aligned with the plurality of staple pockets defined in the anvil member. The buttress mount is detachably secured with the shaft of the anvil component. The buttress mount includes at least one support member radially extending outward to secure the buttress member to the anvil member. The buttress mount at least partially underlying the buttress member to provide support thereto.
- In an embodiment, the buttress mount may further include an annular ring member from which the at least one support member radially extends outward. The annular ring member may be configured and dimensioned to receive the shaft of the anvil component therethrough. The at least one support member may be disposed radially inward of the plurality of staple pockets. A radially outer peripheral portion of the at least one support member may be flush with a peripheral edge of the anvil member. The at least one support member may also extend radially outward of at least one of the annular rows of staple pockets. Alternatively, the at least one support member may at least partially overlie at least one of the annular rows of staple pockets.
- The at least one support member may have a radially varying thickness. The buttress member may have an annular configuration. In particular, the buttress member may be disposed in a juxtaposed relation with the plurality of staple pockets. The buttress mount may engage a proximal surface of the buttress member. Alternatively, the buttress mount may engage a distal surface of the buttress member. The buttress member may be made of a biodegradable material. The anvil member may define a recess configured and dimensioned to receive the buttress mount therein to provide securement of the buttress mount therein. The at least one support member of the buttress mount may engage an inner wall of the recess to provide securement of the buttress mount thereagainst. The buttress member and the buttress mount may be monolithically formed as a single construct. In addition, the apparatus may further include a knife member concentrically arranged with the plurality of surgical staples in the staple cartridge component. The knife member may be movable relative to the staple cartridge component. In particular, the at least one support member of the buttress mount may be disposed radially inward of the knife member when the knife member engages the buttress member.
- In accordance with another embodiment of the present disclosure, there is provided an apparatus for joining two hollow organ sections with an annular array of surgical staples. The apparatus includes a staple cartridge component, an anvil component, a knife member, a buttress member, and a buttress mount. The staple cartridge component includes a plurality of surgical staples in an annular array. The anvil component defines a plurality of staple pockets for deforming the surgical staples. The anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to adjustably clamp tissue between the staple cartridge and anvil components. The knife member is concentrically arranged with the plurality of surgical staples in the staple cartridge component. The knife member is movable relative to the staple cartridge component. The buttress member is concentrically aligned with the anvil component. The buttress mount is detachably secured with the anvil component. The buttress mount includes a core ring, an outer ring, and at least one spoke extending between and interconnecting the core ring and the outer ring. The buttress mount is configured and adapted to secure the buttress member with the anvil member. The buttress mount at least partially underlying the buttress member to provide support thereto.
- In an embodiment, the buttress member may be concentrically aligned with the plurality of staple pockets. The outer ring may at least partially overlap the plurality of staple pockets in the annular array. The buttress mount may engage a proximal surface of the buttress member. The buttress mount may engage a distal surface of the buttress member. The outer ring may be disposed radially inward of the knife member when the knife member is actuated to engage the buttress member.
- In accordance with still another embodiment of the present disclosure, there is provided an apparatus for joining two hollow organ sections with an annular array of surgical staples. The apparatus includes a handle assembly, an elongate tubular member, a staple cartridge component, an anvil component, a knife member, a buttress member, and a buttress mount. The handle assembly includes a firing trigger. The elongate tubular member extends distally from the handle assembly. The staple cartridge component is coupled to a distal portion of the elongate tubular member. The staple cartridge component includes a plurality of surgical staples in an annular array. The anvil component defines a plurality of staple pockets for deforming the surgical staples. The anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to clamp tissue between the staple cartridge and anvil components. The knife member is concentrically arranged with the plurality of surgical staples in the staple cartridge component. The knife member is movable relative to the staple cartridge component. The buttress member is concentrically aligned with the anvil component. The buttress mount is detachably secured with the anvil component. The buttress mount includes at least one support member radially extending outward, from a shaft of the anvil component when the buttress mount is mounted on the anvil component to secure the buttress member to the anvil component. The buttress mount at least partially underlies the buttress member to provide support thereto.
- In an embodiment, the buttress mount may further include an annular ring member from which the at least one support member radially extends outward. The at least one support member may be disposed radially inward of the plurality of staple pockets. A peripheral portion of the at least one support member may be flush with a peripheral edge of the anvil member. The at least one support member may extend radially outward of at least one of the annular rows of staple pockets. The at least one support member may at least partially overlie at least one of the annular rows of staple pockets.
- Various embodiments of the present disclosure are described hereinbelow with reference to the drawings, wherein:
-
FIG. 1 is a perspective view of an annular surgical stapling apparatus configured for use with a surgical buttress assembly in accordance with an embodiment of the present disclosure, illustrating an anvil assembly and the buttress assembly detached from the surgical stapling apparatus; -
FIG. 2 is an exploded perspective view of the anvil assembly and the buttress assembly of the surgical stapling apparatus ofFIG. 1 with parts separated; -
FIG. 3 is a perspective view of the anvil assembly ofFIG. 2 having the buttress assembly ofFIG. 2 mounted thereon; -
FIG. 4 is a cutaway perspective view of the area of detail indicated inFIG. 3 ; -
FIG. 5 is an exploded perspective view of the anvil assembly and the buttress assembly ofFIG. 2 with parts separated, illustrating invertible use of the buttress assembly; -
FIG. 6 is a perspective view of the anvil assembly ofFIG. 5 having the buttress assembly ofFIG. 5 mounted thereon; -
FIG. 7 is an exploded perspective view of the anvil assembly ofFIG. 1 and a buttress assembly in accordance with another embodiment of the present disclosure, with parts separated; -
FIG. 8 is a perspective view of the anvil assembly ofFIG. 1 having a buttress assembly in accordance with another embodiment of the present disclosure mounted thereon; -
FIG. 9 is a cutaway perspective view of the area of detail indicated inFIG. 8 ; -
FIG. 10 is a perspective view of the anvil assembly ofFIG. 1 having a buttress assembly in accordance with another embodiment of the present disclosure mounted thereon; -
FIG. 11 is a cutaway perspective view of the area of detail indicated inFIG. 10 ; -
FIG. 12 is an exploded perspective view of the anvil assembly ofFIG. 1 and a buttress assembly in accordance with another embodiment of the present disclosure with parts separated; -
FIG. 13 is a side cross-sectional view of a buttress assembly ofFIG. 12 taken along section line 13-13 inFIG. 12 ; -
FIG. 14 is a perspective view of the annular surgical apparatus ofFIG. 1 , illustrating insertion of the apparatus through two hollow organ sections; -
FIG. 15 is an enlarged, partial longitudinal cross-sectional view of a head portion of the apparatus ofFIG. 14 ; -
FIG. 16 is an enlarged view of the area of detail indicated inFIG. 15 ; and -
FIG. 17 is an enlarged, partial longitudinal cross-sectional view of the head portion of the apparatus ofFIG. 15 , illustrating stapling and cutting of the two hollow organ sections. - Embodiments of the present disclosure will now be described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “distal,” as is conventional, will refer to that portion of the instrument, apparatus, device or component thereof which is farther from the user while, the term “proximal,” will refer to that portion of the instrument, apparatus, device or component thereof which is closer to the user. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.
- With reference to
FIG. 1 , asurgical stapling apparatus 10 for performing circular anastomosis of hollow organs is shown.Surgical stapling apparatus 10 drives a circular array of staples 7 (FIG. 15 ) through the end sections of each organ and simultaneously fires an annular knife 76 (FIG. 15 ) to sever any tissue interior of the driven circular array of staples 7 to free the tubular passage, and thereby joining two ends of the organ.Surgical stapling apparatus 10 includes ahandle assembly 20 having a pair of pivotableactuating handle members 22 and an advancingmeans 24 including arotatable grip member 26, anelongate body portion 30 extending distally fromhandle assembly 20, and ahead portion 50 including ananvil assembly 60, astaple cartridge assembly 70, and a surgical buttressassembly 100 in accordance with an embodiment of the present disclosure. The components ofsurgical apparatus 10 are generally formed from thermoplastics including polycarbonates, and metals including stainless steel and aluminum. The particular material selected to form a particular component will depend upon the strength requirements of the particular component. Staples 7 are of a conventional type and include a backspan having a pair of legs extending from the backspan. The legs terminate in tissue penetrating tips. - Handle
assembly 20 can be actuated toapproximate anvil assembly 60 relative tostaple cartridge assembly 70 and to apply a pair of annular arrays of staples 7 through tissue. In order to properly position tissue inhead portion 50,rotatable grip member 26 may be rotated to moveanvil assembly 60 axially relative tostaple cartridge assembly 70 between a spaced apart position and an approximated position in whichanvil assembly 60 is positioned adjacentstaple cartridge assembly 70 to clamp tissue therebetween.Handle members 22 may be squeezed to fire staples 7 through tissue to join two segments “T1,” “T2” (FIG. 14 ) of tubular tissues together, as will be discussed in detail below. -
Elongate body portion 30 is constructed to have a slightly curved/bent shape along its length. However,elongate body portion 30 may also be straight, as well as flexible to bend to any configuration. The length, shape and/or the diameter ofelongate body portion 30 may be varied to suit a particular surgical procedure. - With reference to
FIGS. 1-4 ,head portion 50 includes, astaple cartridge assembly 70, ananvil assembly 60 and a surgical buttressassembly 100 detachably secured withanvil assembly 60.Staple cartridge assembly 70 may be fixedly connected to a distal end portion ofelongate body portion 30 or may be configured to concentrically fit within the distal end portion ofelongate body portion 30. In particular,staple cartridge assembly 70 defines a pair of annular arrays of staple receiving slots 72 (FIG. 15 ) having a staple 7 disposed in each one of staple receiving slots 72. In addition,staple cartridge assembly 70 includes acylindrical knife 76 concentrically arranged with the pair of annular array of staples 7 and a plurality of staple pushers 9 (FIG. 15 ) each disposed in staple receiving slot 72 to eject staple 7 through slot 72. Staples 7 travel through slots 72 and tissue towardanvil assembly 60. - With brief reference to
FIG. 15 ,cylindrical knife 76 includes adistal rim 79 defining a knife blade adapted to cut tissue and portions of surgical buttressassembly 100. Upon actuation ofhandle members 22,cylindrical knife 76 is moved distally to cut tissue and portions of surgical buttressassembly 100, and the plurality of pushers 9 are moved distally to eject staples 7 from the staple receiving slots 72 towardanvil assembly 60. - With particular reference back to
FIG. 2 , positioned distally ofstaple cartridge assembly 70 isanvil assembly 60 including ananvil member 62 and ashaft 64 extending proximally fromanvil member 62.Anvil member 62 includes a plurality ofstaple pockets 65 for receiving and deforming staples 7.Shaft 64 is configured to be detachably received in approximation shaft 75 (FIG. 1 ) disposed inelongate body portion 30.Approximation shaft 75 is operatively coupled withrotatable grip member 26 ofhandle assembly 20, whereby rotation ofrotatable grip member 26 moves approximationshaft 75 axially. Such axial movement ofapproximation shaft 75 is imparted toanvil assembly 60. In this manner,anvil assembly 60 is movable axially relative tostaple cartridge assembly 70 between a spaced apart position and an approximated position in whichanvil assembly 60 is positioned adjacentstaple cartridge assembly 70 to adjustably clamp tissue betweenanvil assembly 60 andstaple cartridge assembly 70. - Examples of instruments for performing circular anastomosis of hollow organs are described in U.S. Pat. Nos. 6,053,390, 5,588,579, 5,119,983, 5,005,749, 4,646,745, 4,576,167, and 4,473,077, each of which is hereby incorporated herein in its entirety by reference.
- With continued reference to
FIGS. 2-4 , a buttressmember 110 and a buttressmount 120 are concentrically arranged with one another.Buttress member 110 is provided to reinforce and seal staple lines applied to tissue bysurgical stapling apparatus 10. -
Buttress member 110 is fabricated from a biocompatible material which is bioabsorbable or non-absorbable, and can also be made from natural or synthetic materials. It should be understood that any combination of natural, synthetic, bio-absorbable, and non-bioabsorbable materials may be used to form buttressmember 110. - In addition, buttress
member 110 may be porous, non-porous, or combinations thereof. It is also envisioned that buttressmember 110 described herein may contain a plurality of layers in which any combination of non-porous and porous layers may be configured. For example, buttressmember 110 may be formed to include multiple non-porous layers and porous layers that are stacked in an alternating manner. In another example, buttressmember 110 may be formed in a “sandwich-like” manner wherein the outer layers of buttressmember 110 include porous layers and the inner layers are non-porous layers. Examples of multi-layered buttress members are disclosed in U.S. Patent Application Publication No. 2009/0001122, filed on Jun. 27, 2007, entitled “Buttress and Surgical Stapling Apparatus,” the entire disclosure of which is hereby incorporated by reference therein. - In particular, the use of non-porous layers in buttress
member 110 may enhance the ability of buttressmember 110 to resist tears and perforations during the manufacturing, shipping, handling, and stapling processes. In addition, the use of a non-porous layer in the surgical buttress may also retard or inhibit tissue ingrowth from surrounding tissues, and thereby act as an adhesion barrier and/or inhibit the formation of unwanted scar tissue. - In addition, at least one bioactive agent may be combined with buttress
member 110. The agent may be disposed on a surface of the surgical buttress and/or impregnated therein. In these embodiments, buttressmember 110 can also serve as a vehicle for delivery of the bioactive agent. The term “bioactive agent,” as used herein, is used in its broadest sense and includes any substance or mixture of substances that have clinical use. - With continued reference to
FIGS. 2-4 , buttressmember 110 has an annular profile configured to be concentrically aligned withanvil assembly 60. In particular, buttressmember 110 is mounted on aproximal surface 66 ofanvil assembly 60, and buttressmount 120 is disposed proximal of buttressmember 110. The annular profile of buttressmember 110 is configured and dimensioned to at least be flush with an outer peripheral edge ofanvil member 62 when mounted onanvil assembly 60. -
Buttress mount 120 includes acore ring 122 and supportarms 124 radially extending outward fromcore ring 122.Support arms 124 are circumferentially arranged aboutcore ring 122 and are configured and dimensioned to be affixed to aproximal surface 112 of buttressmember 110 by, for example, over molding, ultrasonic welding, melt pressing or melt pressing in conjunction with other polymers or with adhesives.Core ring 122 includes ahole 123 configured and dimensioned to receiveshaft 64 ofanvil assembly 60 therethrough when being mounted toanvil assembly 60. In particular,hole 123 is configured and dimensioned to provide a tight or friction fit againstshaft 64 to enable securement of buttressmember 110 betweenanvil member 62 and buttressmount 120. It is contemplated thatcore ring 122 may be configured as a split ring (i.e., including a break along a length thereof) to accommodate various diameter shafts. - Other shapes for the buttress support are contemplated, and the buttress support may incorporate straight or curved members having a variety of cross-sectional shapes.
- With particular reference now to
FIG. 4 , buttressmember 110 is in a superposed relation with the pair of annular arrays ofstaple pockets 65 defined inanvil member 62. In particular, radially extendingsupport arms 124 of buttressmount 120 are configured and sized to terminate radially inward of the pair of annular arrays ofstaple pockets 65, such that when staples 7 are ejected through the pair of annular arrays of staple receiving slots 72, the legs of each staple 7 penetrate through tissue and buttressmember 110 into staple pockets 65. Under such a configuration, supportarms 124 of buttressmount 120 are not affected by the staple formation and, likewise, the support arms do not affect the staple formation. In this manner, upon actuation ofhandle members 22, a portion of buttressmember 110 is stapled with tissue to reinforce tissue, and the remaining portions of buttressmember 110 and buttressmount 120 are cut and detached from the portion of buttressmember 110 stapled with tissue. However, it is also contemplated thatsupport arm 124 may be configured and sized to terminate radially inward ofcylindrical knife 76 whencylindrical knife 76 is actuated to cut tissue and buttressmount 120. In this manner, severing ofsupport arm 124 bycylindrical knife 76 may be eliminated. - With reference now to
FIGS. 5 and 6 , it is also envisioned that buttressassembly 100 may be used in an inverted position. Specifically, buttressmount 120 is secured with buttressmember 110, by any of the methods described hereinabove, so that the buttressmount 120 is arranged distal of buttressmember 110. Furthermore, buttressmount 120 may be configured and dimensioned to be received in arecess 67 defined inanvil member 62. Additionally or alternatively, ahole 123 defined bycore ring 122 provides a tight fit againstshaft 64 ofanvil assembly 60. Moreover, supportarms 124 are configured and dimensioned to provide a tight fit with a peripheral edge ofrecess 67, which further improves the securement of buttressmember 110 withanvil assembly 60. - The distal arrangement of buttress
mount 120 with respect to buttressmember 110 can provide a flat surface contact between buttressmember 110 and theproximal surface 66 ofanvil member 62, to thereby further enhance staple formation through tissue. - With reference now to
FIG. 7 , it is also envisioned that buttressmember 110 may be supported by a pair of buttress mounts 520 a, 520 b. In particular, buttress mount 520 a is arranged distal of buttressmember 110, and buttress mount 520 b is arranged proximal of buttressmember 110. Buttress mounts 520 a, 520 b are attached to buttressmember 110 by any of the methods described hereinabove. Buttress mounts 520 a, 520 b are substantially identical to buttressmount 120 described hereinabove, and thus will not be described herein in the interest of brevity. Buttress mounts 520 a, 520 b are substantially identical and as such, buttressassembly 500 may be used interchangeably.Holes 523 of respective buttress mounts 520 a, 520 b are configured and dimensioned to receiveshaft 64 ofanvil assembly 60 therethrough to provide a tight or friction fit therewith. In addition, buttress mount 520 a includesupport arms 524 radially extending outward fromcore ring 522 to provide a tight fit around the peripheral edge ofrecess 67 ofanvil assembly 60 to further improve securement of buttressmember 110 withanvil assembly 60. The entire assembly may be inverted, and buttress mount 520 b may also includesupport arms 524 configured and dimensioned to provide a tight fit against the peripheral edge ofrecess 67 ofanvil assembly 60. Whilesupport arms 524 of buttress mount 520 a are shown to be in radial registration withsupport arms 524 of buttress mount 520 b, it is contemplated thatsupport arms 524 of buttress mounts 520 a, 520 b may be out of radial registration with one another. The buttress mounts 520 a and 520 b may have different configurations including arms that are curved or straight, having a variety of cross-sectional shapes. The configuration of buttress mount 520 a may be different from the configuration of buttress mount 520 b. - With reference to
FIGS. 8 and 9 , it is further contemplated that a buttressmount 220 may includesupport arms 224 that radially extend outward from acore ring 222 and that are substantially flush with an outer peripheral edge ofanvil member 62 when mounted onanvil assembly 60. Under such a configuration, a portion of eachsupport arm 224 is stapled to tissue to reinforce tissue, and the remaining portions (i.e., portions radially inward of cylindrical knife 76) of buttressmember 110 and buttressmount 120 are cut and detached from the portion of buttressmember 110 that is stapled to tissue. - By providing a greater area of contact between buttress
member 110 and supportarms 224, the force applied to buttressmember 110 bysupport arms 224 is more evenly distributed throughout buttressmember 110, which may inhibit tearing or damage to buttressmember 110. Under such a configuration, it is further contemplated that supportarms 224 may have varying thickness. In particular, a portion ofsupport arm 224 that is stapled to tissue may have a minimal thickness, e.g., a thickness substantially smaller than the thickness of a portion ofsupport arm 224adjacent core ring 222, such that any effect of the thickness ofsupport arms 224 on staple formation is minimized. In addition, it is further envisioned that the portion ofsupport arms 224 that are stapled with buttressmember 110 may be formed of bioabsorbable and/or biodegradable material. - With reference to
FIGS. 10 and 11 , a buttressmount 320 in accordance with another embodiment of the present disclosure is illustrated.Buttress mount 320 includes acore ring 322 configured and dimensioned to receiveshaft 64 ofanvil assembly 60 therethrough, anouter ring 326 concentrically arranged withcore ring 322 and spokes 324 radially extending outward fromcore ring 322 toouter ring 326, thereby interconnectingcore ring 322 andouter ring 326.Outer ring 326 provides additional support for buttressmember 110 againstanvil member 62. In particular,outer ring 326 may greatly reduce the potential for buttressmember 110 to fold over, dislodge or separate fromanvil assembly 60. In particular, the force applied to buttressmember 110 by buttressmount 320 is more evenly distributed throughout buttressmember 110, which may inhibit tear or damage to buttressmember 110. - With particular reference to
FIG. 11 ,outer ring 326 is at least partially disposed in the staple formation portion of buttressmember 110, whereby only a portion ofouter ring 326 is stapled to buttressmember 110 and tissue, and the remaining portions ofouter ring 326 are cut and detached from the portion of buttressmember 110 stapled to tissue. As discussed hereinabove with respect to supportarm 224,outer ring 326 may have a minimal thickness at a peripheral portion thereof to minimize interference with staple formation. Additionally,outer ring 326 and/or buttressmount 320, as a whole, may be made of biodegradable and/or bioabsorbable material, such that the portion ofouter ring 326 that is stapled to buttressmember 110 and tissue is degraded over time. Alternatively, theouter ring 326 can be positioned inwardly of the staple line, or inwardly of the cut line. - With reference to
FIGS. 12 and 13 , while buttress mounts 120, 220, 320 and buttressmember 110 have been described hereinabove as separate components that are attached to each other by the methods describe hereinabove, it is also envisioned that buttress member and buttress support may be monolithically formed as a single construct. Monolithically formed buttressassembly 400 defines a common throughhole 423 configured and dimensioned to receiveshaft 64 ofanvil assembly 60 therethrough to provide a tight fit therewith. Alternatively, the buttress member and buttress support can be formed from different materials that are bonded or otherwise attached to one another. - With reference now to
FIGS. 14-17 ,surgical stapling apparatus 10 is used in an anastomosis procedure to effect joining of, for example, two opposing intestinal sections “T1,” “T2.” The anastomosis procedure is typically performed using minimally invasive surgical techniques including laparoscopic means and instrumentation. Initially, a diseased intestinal section is removed. Thereafter,anvil assembly 60 is inserted to the operative site either through a surgical incision or transanally and is positioned within the intestinal section “T1.”Elongate body portion 30 ofsurgical stapling apparatus 10 includingstaple cartridge assembly 70 is inserted transanally into the other intestinal section “T2.” Intestinal sections “T1,” “T2” are then temporarily secured about their respective components (e.g.,shaft 64 ofanvil assembly 60 and the distal end of elongate body portion 30) by conventional means such as a purse string suture “P.” - Thereafter, the clinician
maneuvers anvil assembly 60 until the proximal end ofshaft 64 is inserted into the distal end ofapproximation shaft 75 disposed inelongate body portion 30 ofsurgical stapling apparatus 10.Shaft 64 engagesapproximation shaft 75 to be operable as a unitary construct, as shown inFIG. 15 .Anvil assembly 60 andelongate body portion 30 are then approximated to approximate intestinal sections “T1,” “T2,” as shown inFIG. 17 .Surgical stapling apparatus 10 is then fired, effecting stapling of intestinal sections “T1,” “T2” to one another, whilecylindrical knife 76 cuts a portion of buttressmember 110 and tissue disposed radially inward ofcylindrical knife 76, and thereby detaching buttressmount 320 and an inner portion of buttressmember 110 from the portion of buttressmember 110 that is clamped (approximated) between distal surface 74 ofstaple cartridge assembly 70 andproximal surface 66 ofanvil assembly 60 to complete the anastomosis. - In a further embodiment, a buttress member can be superposed in relation with the annular rows of staple slots defined in the
staple cartridge assembly 70. In a particular example, radially extending support arms of buttress mount are attached to a core ring and are configured and sized to terminate radially inward of the pair of annular rows of staple slots 72 (seeFIG. 15 ), such that when staples 7 are ejected through the pair of annular arrays of staple receiving slots 72, the legs of each staple 7 penetrate through tissue and buttress member into staple pockets 65. Alternatively, the support arms can terminate adjacent the rows of staple slots 72. Upon actuation ofhandle members 22, a portion of buttress member is stapled with tissue to reinforce tissue, and the remaining portions of buttress member and/or buttress mount are cut and detached from the portion of buttress member stapled with tissue. The support arms can be configured to engage the inner surface of a recess in the staple cartridge assembly. Additionally or alternatively, the core ring of the buttress support frictionally engages the shaft. In addition, in certain embodiments, a pair of buttress supports can be used to mount the buttress member on the staple cartridge, as discussed above. - Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, the above description, disclosure, and figures should not be construed as limiting, but merely as exemplifications of particular embodiments. For example, buttress member and buttress support may be secured with
approximation shaft 75 disposed instaple cartridge assembly 70, whereby buttressassembly 100 is in a superposed relation with a tissue contacting surface ofstaple cartridge assembly 70. It is to be understood, therefore, that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure.
Claims (19)
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US9237892B2 (en) | 2011-12-14 | 2016-01-19 | Covidien Lp | Buttress attachment to the cartridge surface |
US9295466B2 (en) | 2012-11-30 | 2016-03-29 | Covidien Lp | Surgical apparatus including surgical buttress |
US9326773B2 (en) | 2012-01-26 | 2016-05-03 | Covidien Lp | Surgical device including buttress material |
US9345479B2 (en) | 2007-03-06 | 2016-05-24 | Covidien Lp | Surgical stapling apparatus |
US9351731B2 (en) | 2011-12-14 | 2016-05-31 | Covidien Lp | Surgical stapling apparatus including releasable surgical buttress |
US9351732B2 (en) | 2011-12-14 | 2016-05-31 | Covidien Lp | Buttress attachment to degradable polymer zones |
US9364234B2 (en) | 2007-06-18 | 2016-06-14 | Covidien Lp | Interlocking buttress material retention system |
US9402627B2 (en) | 2012-12-13 | 2016-08-02 | Covidien Lp | Folded buttress for use with a surgical apparatus |
US9414839B2 (en) | 2013-02-04 | 2016-08-16 | Covidien Lp | Buttress attachment for circular stapling device |
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EP2620105A1 (en) | 2013-07-31 |
EP2962647A1 (en) | 2016-01-06 |
JP6108601B2 (en) | 2017-04-05 |
US9186144B2 (en) | 2015-11-17 |
US9010612B2 (en) | 2015-04-21 |
AU2012268923B2 (en) | 2017-06-22 |
US20130193191A1 (en) | 2013-08-01 |
JP2013154166A (en) | 2013-08-15 |
CA2799088A1 (en) | 2013-07-26 |
EP2962647B1 (en) | 2017-11-08 |
JP2017074388A (en) | 2017-04-20 |
AU2012268923A1 (en) | 2013-08-15 |
ES2551247T3 (en) | 2015-11-17 |
EP2620105B1 (en) | 2015-09-30 |
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